Tag Archives: public health

From Nursing Mental Diseases, by Harriet Bailey, RN

MS. BAILEY WROTE IN 1929:

In the prevention of mental deficiency segregation is recognized as a most important measure, for these individuals have not the mental qualities which make them valuable to society, and economically they are a partial or a total loss. Furthermore, it is an established fact that this type of defective family increases at about double the rate of the general population, that feeblemindedness is inherited, for parents cannot transmit to their children nervous and mental strength which is not theirs to give. From some recent studies made of the feebleminded, it has been shown that not all mental defectives are a social menace, and therefore in need of segregation. Thees studies have also shown that when properly educated and specially trained in the manual and industrial arts, many of them become quiet, law-abiding, useful citizens. Experience also shows that only through education and supervision may they be saved from lived of inefficiency, failure, dependency, and misery.

IN SPITE OF WHAT YOU MAY HAVE READ IN MY FAVORITE NEWSPAPER (the NY Times):

Chagas’ Disease, while being a medical nightmare, is not the new AIDS.

The first, and perhaps biggest problem with this article is calling Chagas’ Disease the “new” anything. Chagas’ disease was discovered in 1909 by a brilliant Brazilian scientist, Carlos Chagas. Chagas’ discovery was justly recognized for this great discovery during his own lifetime.

Chagas’ disease is like AIDS, in that it targets certain populations, but that is where the similarity stops. Chagas’ disease is spread by a vector (bugs of the family Reduviidae) that is exquisitely evolved to infect the poor, as it is related to low-quality housing. AIDS does target the poor of the world more than the rich, but there are certain groups that AIDS targeted, or continues to target, that have nothing to do with economic standing. AIDS is not transmitted by arthropod vectors (though there was concern in the early years of the pandemic), but by sexual contact and contaminated transfusions and medical equipment. Chagas’ disease can be spread by transfusion, but this risk is decreasing. As of a few years ago,around two decades after the blood supply began being screened for HIV, the blood supply in the US began being screened for Chagas’ disease.

Chagas’ disease is called a Neglected Tropical Disease. These are diseases that have high prevalence in the hotter regions of the globe, affect a large number of people but yet do not get a lot of attention from the press, their governments, NGOs, and even much of the local population. For example, many residents of Lima (where the power is) don’t even know what Chagas’ disease is, even though it afflicts a large number of Peruvians. Why? It doesn’t occur in Lima, and public education about the disease does not extend to those who won’t get it, even though they may be the ones most able to help.

Stigma: Yes, it sucks to get AIDS or Chagas’ or both together. But tell me from your heart of hearts: Which would you rather tell your co-workers and parents–that you’ve contracted HIV or that you’ve contracted Chagas’. I’m betting on Chagas’. 30 years into the epidemic, and HIV/AIDS still carries a burden unmatched by any other disease.

Research funding: No comparison. HIV/AIDS has been a research juggernaut over much of the pandemic. As a result, we’ve made brilliant and amazing progress in treatment and prevention of the disease. Chagas’ disease is still treated by the same two lousy drugs that were used over a decade ago. Some research is being done on new treatments, but I you’d be embarrassed to see the shoestring some of those labs run on. Moreover, most of these studies involve using drugs that were already approved for other indications, such as anti-fungals and anti-malarials.(They ain’t much money to make sellin’ drugs to po’ folk in the developin’ world.)

THAT’S WHY YOUR HEALTH INSURANCE DOESN’T COVER IT

ONE would think, to judge by the way health care insurance is provided, that the mouth is some separate entity, rather than the part of your body you probably use the most. Dental insurance, then, becomes like the rider to your homeowner’s insurance that covers your grandmother’s jewelry or your collection of stamps–it requires some sort of different coverage. I don’t know how the hell you’re supposed to eat, drink, kiss, or bite the fingers off of your predators without a mouth, but health insurance separates this one very important part of your body from everything else. It’s a historical anomaly, and one that should have been corrected when we let surgeons become doctors. If you haven’t noticed already, there’s a fair amount of pathology that can occur within the oral cavity, and much of it is related to illnesses elsewhere in the body.

Why doesn’t basic health care insurance cover problems to the teeth and gums? My primary care doctor’s exam of my mouth is brief and cursory. Would he be able to tell if I were unable to chew my food properly? Would he know where to look for the most common oral tumors?

I went to public health school at Boston University. They have a dental school. Were teeth or oral health even mentioned once during my time there? (That was a rhetorical question. No, of course, they were not. You would think that with the fluoridation of water being cited as one of the ten greatest public health measures of the 20th century that a light bulb might have gone off over someone’s head, but you would be wrong.)

Why am I thinking about all of this? Well, for one reason, I am now in the situation of shopping for dental insurance. Want to know what I’ve learned? Dental insurance sucks raw eggs. It eats donkey dung. It takes your premiums and then sneers at your pain. Worse than that, it doesn’t do enough for children who are going to need lots of care in order to get the smile that is required for getting a good job in this society.

Dentistry, as sufferers from dental problems know, does not come cheaply. According to thewealthydentist.com, a 2009 survey found the average root canal fee is $740 for a front tooth and $1,000 for a molar. Considering that the average dental insurance only pays around 60-70% for these procedures, the bill will come with an out-of-pocket expense of around $300. Benefits with most plans generally max out at around $1000-$1300 per year, and you can see that it’s going to take some serious jack if you’ve got more than an occasional problem.

Those of us who were lucky enough to grow up in financial security, along with parents who appreciated the fact that one is neither employable nor datable with a rotten mouth, can most likely survive with this insurance. It sensibly pays for two cleanings a year, helping the insurance company avoid having to pay out for more sever problems. But if you’re the person who grew up in where water wasn’t fluoridated, where you parents had rotten teeth, etc, you’re probably not in position to pay for all the work that needs to be done.

Article Abstract

BACKGROUND: High occupational suicide rates are often linked to easy occupational access to a method of suicide. This study aimed to compare suicide rates across all occupations in Britain, how they have changed over the past 30 years, and how they may vary by occupational socio-economic group.

METHODS: We used national occupational mortality statistics, census-based occupational populations and death inquiry files (for the years 1979-1980, 1982-1983 and 2001-2005). The main outcome measures were suicide rates per 100 000 population, percentage changes over time in suicide rates, standardized mortality ratios (SMRs) and proportional mortality ratios (PMRs).

RESULTS: Several occupations with the highest suicide rates (per 100 000 population) during 1979-1980 and 1982-1983, including veterinarians (ranked first), pharmacists (fourth), dentists (sixth), doctors (tenth) and farmers (thirteenth), have easy occupational access to a method of suicide (pharmaceuticals or guns). By 2001-2005, there had been large significant reductions in suicide rates for each of these occupations, so that none ranked in the top 30 occupations. Occupations with significant increases over time in suicide rates were all manual occupations whereas occupations with suicide rates that decreased were mainly professional or non-manual. Variation in suicide rates that was explained by socio-economic group almost doubled over time from 11.4% in 1979-1980 and 1982-1983 to 20.7% in 2001-2005.

CONCLUSIONS: Socio-economic forces now seem to be a major determinant of high occupational suicide rates in Britain. As the increases in suicide rates among manual occupations occurred during a period of economic prosperity, carefully targeted suicide prevention initiatives could be beneficial.

First of all, lice are very species specific. Cattle lice (there are 4 common kinds in the United States) do not infect sheep. Sheep lice do not infect hogs. And what ever Rick Santorum’s current anxieties are, no species of animal lice infects people. I am sure that he will sleep better knowing this.

Secondly, lice are often quite specific to an area of the body. Human head lice (Pediculis capitis humanus) stay on the head. They do not like moving towards the torso. They like to lay their eggs on hair.

Picture from Wikimedia Commons

Body lice–Pediculus humanus humanus, or sometimes Pediculus humanis corporis–are indistinguishable from head lice, yet except in the laboratory, they will not breed with head lice. They prefer to lay eggs in clothing, especially along the seams. (Bad infestations, therefore, can be prevented by avoiding clothing.)

Thirdly, there is an important distinction between head lice and body lice from an epidemiological point of view. Head lice really don’t cause any serious problems. Kids get sent home from school, squeamish parents lose it and stay up all night itching–even though they are not infested–and the washing machine and vacuum cleaner do overtime. However, other than the chaos and the irrational panic, there is little to worry about.

Body lice, on the other hand, are the vector for some rather serious diseases.

Epidemic typhus

Spread in the feces of lice (like Chagas’ Disease), epidemic typhus is caused by infection with the bacteria Rickettsia prowazekii. Typhus is one of the reasons that, at least until our last couple of wars, more death to soldiers and civilians during conflicts has been caused by germs and disease than by bullets, cannonballs, spears, arrows, bayonets, bombs…..

Trench Fever

Caused by the bacteria Bartonella quintana, trench fever is described as a “moderately serious” disease, and though rarely lethal, was responsible for yet another of the epidemics that plagued soldiers during the War to End All Wars. It is not to be confused with Trench Mouth or Trench Foot, both of which also plagued soldiers in the First World War.

Louse-Borne Relapsing Fever

Caused by Borrelia recurrentis, relapsing fever occurs epidemically in areas of poverty and deprivation. It is currently prevalent in Sudan. If left untreated, mortality rates can reach 30%-70%

Take home message: Head lice don’t cause disease, and war, poverty, and deprivation are bad for your health.

As I mentioned, I support the Occupy movements for the most part. There does exist anti-Zionist faction that drives me to distraction, but my hopes are that domestic solidarity will suffice for most, and that we will abandon the need to identify with every group that we perceive as downtrodden. If we do have to pick a nation upon which to lavish our sympathy, my vote will be for the Congo.

Politics, however, are the purview of the Meta-Bug, and here we try to stay focused on health matters (and drinks and dishes). And the health matter at Occupy Boston that has me grinding my (unstained nonsmoker’s) teeth is the high rate of smoking that is going on at Dewey Square. Of course, if someone wants to fill his or her lungs with a foul and loathsome gas chock full o’ carcinogens, that is more or less that person’s right. However, second-hand smoke is so noxious that even outdoors it is capable of causing damage, irritating the airways of asthmatics and exposing others to its risks.

Alas, Occupy Boston has been unable to designate a separate area for smokers, at least by the time of my last visit. “That would be segregation,” complained one fuzzy young smoker, obviously quite annoyed that someone would suggest segregation at an Occupy campsite. I tried to engage the smoker, explaining that separating people by behaviors which they could control, behaviors that could harm others, was not the same as segregating people by the color of their skin or the gods to whom they prayed.

In the end I think it came down to smokers just not wanting to give up their smokes. Now I can understand that living for days at a time on what is essentially a traffic island, attending General Assemblies for hours at a time, and eating cold donated food for a few weeks could engender an enormous desire to light up. But saying that smokers while smoking shouldn’t be kept at a distance from non-smokers is anti-science, and turns a back on the hard-fought and enormous gains made in public health by working to restrict smoking.

It reflects poorly on the Occupy movement not that they smoke, but that Occupy smokers believe that it is there right to put out second-hand smoke without restriction. The Occupy smokers should just admit that they are addicts and that they need their fix. What’s really at issue is the ability to reflect on one’s own behavior, and be as critical of it as one is of the behavior of others.

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An Online Journal of Chagas’ Disease, Rabies, Beverages from South America, Dishes from the Sixties, and Other Public Health Issues

If you wish to read the Chagas' Disease primer in order, click here to go to Part 1 and follow the links.
We do not wish to diminish the importance of Chagas' disease, or make it seem that we are equating its significance with that of Pisco Sours or Inca Kola--we realize, alas, that for the most part only geeks and do-gooders are interested in diseases like Chagas'. We are hoping that by including matters of interest to the general public that we may attract more readers.

Richard Lerner

Richard Lerner is the author of this blog. All complaints should be sent to anyone other than him. We are looking for other writers interested in vector-borne disease, or timely information on the fight against these conditions, especially in the Americas.